High blood pressure during pregnancy: a not-so-rare situation to be taken very seriously!

Pregnancy is a special time in a woman's life. It is accompanied by cardiovascular physiological changes. In particular, there is a significant drop in blood pressure during the first two trimesters of pregnancy, due to major vasodilatation of the arteries.
In some cases, blood pressure may not fall normally, or may even rise. When blood pressure exceeds 140/90 mm Hg, the diagnosis of hypertension of pregnancy is made.
Arterial hypertension during pregnancy reflects a defect in the manufacture and development of the placenta. It appears after 20 weeks of amenorrhea and should disappear within 3 months of delivery. If blood pressure is high from the start of pregnancy and before the 4th month, there is already unrecognized chronic hypertension prior to pregnancy.
The risk of developing pregnancy-induced hypertension increases with age (after 35), in overweight or obese women, multiparous women, smokers, diabetics, stress and medically-assisted pregnancies. Twin pregnancies also increase the risk of poor placentation. Other factors known to obstetricians are also involved, and are investigated when the diagnosis of hypertension is confirmed.
Why and when should I monitor my blood pressure during pregnancy?
Regardless of your previous history, a blood pressure measurement is recommended at every prenatal visit throughout your pregnancy.
If your blood pressure is elevated at the prenatal check-up (> 140/90 mm Hg), we recommend that you take a blood pressure measurement outside the doctor's office (24-hour measurement = 24-hour blood pressure holter), or self-measure blood pressure on the arm, with the results analyzed by the cardiologist and obstetrician.
Confirmed hypertension is the most frequent complication of pregnancy, affecting 5 to 10% of women. It is usually asymptomatic. In some cases, however, it can give rise to symptoms such as headaches, visual disturbances, epigastric pain, ringing in the ears, etc. You should therefore remain vigilant for these warning symptoms, and consult your maternity hospital if you have the slightest doubt.
Because if hypertension is not detected and controlled, the clinical situation can quickly worsen and develop into pre-eclampsia, which can have very serious consequences for both mother and fetus.
This monitoring is also accompanied by a check of proteins (albumin) in the urine (called proteinuria and albuminuria when pathological).
What if I already have high blood pressure before starting my pregnancy?
If you already have chronic hypertension, it's essential to discuss your pregnancy plans with your doctor. Some blood pressure medications, such as ACE inhibitors, angiotensin receptor blockers and spironolactone, are contraindicated in the second trimester of pregnancy, as they may be harmful to the developing fetus. Your doctor will make changes to your treatment before starting your pregnancy, as permitted by nicardipine or labetalol, for example (www.CRAT.fr).
Finally, if your blood pressure is not balanced before and/or at the start of pregnancy, it is important to consult a specialist in hypertension to carry out a specific assessment of your hypertension and adapt your treatment.
What is pre-eclampsia?
Pre-eclampsia is a disease specific to pregnancy, a renal and sometimes hepatic complication of poor placentation. The fetus is not properly nourished. It can be complicated by organ failure in the mother, including the brain, kidneys and liver, and can even endanger the mother's health. It is an absolute emergency.
It occurs in the 2nd trimester of pregnancy (after 20 weeks' gestation) and is diagnosed by the presence of high blood pressure, often severe, and protein in the urine.
It can lead to intra-uterine growth retardation, fetal distress, prematurity and sometimes fetal death in utero.
Placental abruption may also occur, with the risk of acute fetal distress (retroplacental hematoma).
In extremely serious cases, it may be necessary to perform a medical termination of pregnancy or an emergency delivery to save mother and child.

How is hypertension treated during pregnancy?
Treatment is essentially based on prevention.
In most cases, your doctor will suggest close follow-up with treatment at a referral obstetrical center. Rest is a very important part of management. Dieting is not recommended during pregnancy. Salt intake should be normal, not excessive.
The introduction of antihypertensive treatment will be discussed on the basis of blood pressure figures (consultation and ambulatory measurements). Lowering blood pressure is particularly useful for mothers. Lowering blood pressure too much can worsen the poor vascularization of the fetus. The obstetrician will find the right balance.

If I have hypertension or pre-eclampsia, do I need any special follow-up after my pregnancy?
In women suffering from gestational hypertension or pre-eclampsia, blood pressure usually returns to normal within 3 months of delivery.
Nevertheless, it is advisable to have your blood pressure checked 3 months after delivery, and to undergo a cardiovascular check-up by a hypertension specialist.
High blood pressure during pregnancy and pre-eclampsia may be indicative of an underlying pathology (e.g. kidney disease) that has been ignored until now.
Finally, even with normalized blood pressure, studies show that the presence of hypertension and/or pre-eclampsia is a marker of longer-term cardiovascular risk. We therefore need to be more vigilant about any associated cardiovascular risk factors. It will be important to monitor blood pressure, particularly during the peri-menopause and even more so during the menopause.
Agir pour le cœur des femmes, through its alert, information and screening initiatives, can help you optimize the management of hypertension, particularly during pregnancy.

To find out more, click here:
Consensus " HTA et grossesse " de la Société Française d'Hypertension Artérielle downloadable at www.agirpourlecoeurdesfemmes.com/rubrique endowment/publications